输尿管封堵取石导管结合钬激光在输尿管中上段结石治疗中的应用

Application of Ureteral Occlusion Device Combined with Holium Laser in Treatment of Upper-Middle Ureteral Calculi

目的评价封堵取石导管在输尿管镜下钬激光治疗输尿管中上段结石的临床应用效果。方法入选55例患者均为输尿管中上段结石,输尿管镜上镜至结石的下端,将封堵导管叶片部越过结石,叶片回拉呈球状,封堵结石近端输尿管,钬激光将结石击碎,回拉封堵取石导管,球状叶片附带结石碎片拖出输尿管。结果所有患者术中无明显输尿管损伤、大出血等严重并发症,52例成功取石,无结石残留,2例输尿管上段结石回落肾内,改经皮肾穿刺造瘘取石术(PCNL)成功取石,1例输尿管结石严重扭曲,置入封堵导管失败,改开放手术取石。结论输尿管封堵导管结合钬激光治疗输尿管中上段结石能有效防止结石漂移,结石残留率低,患者容易接受,在输尿管中上段结石的治疗中有较高的临床应用价值。

Objective To evaluate the clinical application of ureteral occlusion device used in ureteroscopic holium laser lithotripsy for treatment of upper-middle ureteral calculi. Methods 55 patients with upper-middle ureteral calculi were treated with holium laser lithotripsy via ureteroscope combined with ureteral occlusion device. Results All opera- tions were successfully performed without obvious ureteral injury and serious bleeding. 52 eases were successfully occluded with stones being completely crushed, 3 eases were not effectively occluded, two of which were treated with percutaneous nephrolithotomy（PCNL） ,one converted to open surgery owing to the tortuosity of the ureter. Conclusions The ureteral occlusion device is worthy of popularization and promotion in favor of preventing calculus migration, increasing stone-free rate, and it is of high clinical application value in the treatment of ureteral upper-middle calculus